Blog Posts

Ginger Wirth

Nurses, like most healthcare professionals, struggle with work/life balance. This stems from the reason that most of us pursued a career in healthcare – an innate desire to care for others.

Your interest in the field may have developed from early exposure to some aspect of healthcare. A family member or personal experience with your own or someone else’s medical issues can ignite the passion for the art of caring for others.

That passion for making a difference in the lives of patients, families and those we work with takes center stage for most nurses in the industry. There are times when our personal needs are put aside, our schedules changed and, sadly, family milestones are missed to execute our craft to the best of our abilities. This apparent oversight is never intentional, but it often creates conflict in our home lives.

It’s a constant struggle to find that delicate balance. This was brought to my attention by my then-5-year-old son, who asked me at the dinner table one evening several years ago, “Mom, are you going to be a nurse forever?” It was a strange question, to be sure, but our dinner table was usually where I’d recount my day in the emergency department. I answered honestly, “Of course I’ll be a nurse forever.” He then bluntly retorted, “Well, then you will never see your grandkids!” and promptly went back to eating his macaroni and cheese. Out of the mouths of babes … I have thought about that question many times throughout the rest of my almost 30-year career. I use it as a barometer when whatever in my professional career seems to be consuming all of my time, or I have inadvertently missed something important in my “outside life.”

Those close to you – your family and friends – deserve your attention and time. A true balance of both only makes you stronger, and both parts of your life get better. And, I would be remiss if I didn’t mention that it’s also important to take time to care for yourself. We cannot effectively take care of others if we are not taking care of ourselves. I wrote a blog article with some tips you may find useful.

The impact that we are able to make on the world through a career in healthcare, and in nursing in particular, is immeasurable. That is undeniable, and truly makes the world a better place.

Ginger Wirth, RN, joined Envision Physician Services in 2013 as a divisional director of clinical services. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as the ideal opportunity to partner with nursing, physicians and facility leaders to make positive changes to the entire patient care experience. Her nearly 30-year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.

We live in a world where surveys surround us. You can’t go to a restaurant, big box store or even a gas station where there isn’t a survey attached to a visit. It has become a reality of the times.

Cashiers at retail stores circle the survey link on the bottom of the register receipts and directly ask us to take time to fill out the survey. And, don’t forget, if you register, you could win a $500 gift card!

Healthcare has been surveying its patients forever, and unbeknownst to the everyday consumer, it’s tied to reimbursement for hospitals and now providers. We rarely mention to patients that they are likely to get a survey on discharge. However, we should encourage everyone on the care team to tell patients and families that there is a survey, and that we will use any and all feedback that is shared to improve care. This feedback is truly a gift, even if it is negative or points out ways we have failed in our mission.

We also have an opportunity to educate our providers and the care team about what the surveys are asking. Do you know what questions are on the HCAHPS survey? Do you know the methodology for selecting who receives a survey? Which patients are given the ED survey? Who gets excluded? Which vendor your facility or organization uses to administer the survey? These are all important answers that should be provided to your care team. If you’re working in a hospital setting and can’t answer these questions, you need to do a bit of studying. Here’s a resource for more information.

There’s nothing to say we can’t make this an open book test. We should ensure that we know the questions on the survey so that we can help educate our patients and families. As healthcare providers, we only get “credit” for those top box results; that is to say the “Very Good” and “9/10” scores. Some providers may not even be aware of that simple fact.

Isn’t it important that we give credence to a survey related to the healthcare we are providing? Surveys and other mechanisms for providing feedback are a sign of our times. Let’s leverage that culture to make the care that we are delivering the best it possibly can be. Let’s use the survey to not only improve, but to showcase the great care we are providing.

Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services for the Alliance Group. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.

In general, we have a tendency to work in silos in healthcare. We tend to focus on the jobs in front of us and the tasks that we need to complete to get to the end point of the encounter, visit or procedure. There are times when we forget or appear to ignore those around us and their contributions to what we are accomplishing. Perhaps we take for granted that the preliminary work gets done, or that the follow up gets completed when we are finished with our part. The reality is that nothing would actually happen without all of the moving parts and the entire team doing exactly their jobs at the right time and place.

We have an opportunity in healthcare to recognize and strengthen those relationships and teams. It’s important to support and thank the parts of the team that may be far in the background, but are crucial to making our task happen or making it easier.

One relationship that is key is the nurse leader-medical director team. This is parallel to a marriage in many ways. Both managers have to be reaching for the same goals and setting the action items together to get to the finish line. There are times when they will not agree on the tactic or maybe even the goal, but there needs to be a constructive way to debate, discuss and ultimately come to an understanding on how to get there.

It’s key that these discussions happen in a private, confidential and safe environment. If they are conducted in the open, the rest of the team may interfere, see any discontent as rationale not to follow the directive, or even use the negativity to undermine the leadership as a whole. To mirror the “marriage” example, the “kids” will try and use “dad” against “mom” to get what they want. It is so important that this key relationship presents a unified front and send clear goals, expectations and the same message.

The other benefit of a healthy, strong and collaborative relationship between the nurse leader and medical director is the support that they can offer each other. Often, there are the same administrative pressures on the nurse leader as the medical director, so it helps to be able to candidly share frustrations, challenges and ways to cope with each other. In the ED world, these key leaders have been selected for their roles due to their strong personalities and leadership qualities. Why not tap into each other’s skills and potential? Share your strengths with each other and hopefully you’ll feel comfortable enough to take feedback to improve yourself or the message you are sending to the team.

The most effective healthcare team works together. It takes every part working well and collaboratively to get results and reach your goals.

Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.

Earlier this month we discussed how modern communication techniques like email and texting can lead to intended communication issues.

The following are 11 tips to help ensure that your message is received and understood the way that you intended:

Do NOT reply to all. Whether it’s business or personal communication via group or mass email, the recipient should never reply to all unless it specifically states to do so in the body of the email.

There are times when an informational email will be sent out as an FYI. Most of the time these emails do not require any response.

If there is a mass inquiry asking for a policy, opinion or other resource, in general the receiver should only respond back to the original sender. If others in the email thread would also like the answer or information, he/she should respond to the original sender asking to have the response shared with them. All too frequently “reply to all” is clicked and instantaneously your inbox is filled with “me too” or “I would like that as well.”

It is courtesy to respond to email requests for information within 24 hours if possible. If you will not be able to meet that guideline, you should use your “Out of Office Assistant” and let others know that your response may be delayed.

If you as the sender require information back within a specific timeline, that needs to be clearly stated in the subject line or within the first few sentences. Also, if the response should be communicated to the entire group, that also should be articulated in the body of the email/request.

Email should be similar to a conversation. Take the time to have some sort of greeting at the beginning and a salutation at the end. Using a keyboard is no excuse for lack of common courtesy.

Review what you’re writing before you hit the “send” button. Once you have hit that button, your communication is out there in cyberspace and there is a slim chance that you will get it back before it is read by the other party. Also make sure that you have the email addressed to the correct person prior to sending/replying/forwarding.

Use “Thank You” replies sparingly. Although it’s always encouraged to be courteous, it’s not always necessary to say thank you back to someone who provides what you asked for.

Make sure that you’re using “high priority” appropriately. Not every message should be tagged as needing an immediate response. If that’s the case, consider picking up the phone and having a conversation verbally.

Acknowledge responses when appropriate. If you ask an individual for information or to complete a task, once that task is completed or you have the requested information, make sure that you communicate, at a minimum, that you’ve received the information and let them know if you need anything additional or you have all that you need.

Understand your electronic audience. If you are communicating with Administration, your wording should be more formal. Save the informal, relaxed communication with your peers and personal email.

Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services for the Alliance Group. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.

Communication. That word is used in every aspect of life and considered one of the most powerful tools we have as human beings. It’s also considered one of the biggest challenges we have. Whether it’s in our professional or personal relationships, when there is the perception of poor, failed or the lack of communication, there is a breakdown of the relationship. There aren’t nearly as many complaints related to the actual work we perform or the acts we do than there are regarding the way we speak (or don’t) speak to each other.

One definition of communication is: A positive, ceaseless, and challenging leadership responsibility of creating and maintaining understanding and trust between people.

It’s important to realize that when conversations happen, the intended purpose is to create a clear understanding to whom the message is being conveyed. The message is not simply made up of words; it includes all of the other important aspects of communication:

Words

Actions

Facial expressions

Tone of voice

Gestures

Silence

All of these make up pieces of the message and play a large part in how the message is received. It’s the responsibility of the sender to ensure that the receiver understands the message. It behooves the sender to be acutely aware of the receiver’s nonverbal cues to ensure that they are getting the information the way it is intended.

The reliance on electronics, such as email, text messages and other nonverbal modes of communication, has created somewhat of a breakdown due to the lack of the essential verbal component as well as the ability to see the other person during the interaction. Care must be taken when relying on these methods as the sole ways of communicating with one another. Consider the potential degradation of communication when we changed from using the telephone as an extension of the verbal to one that puts nonverbal communication “on demand.” Perhaps we should rely more on “old school” communication and go back to actually calling to speak with a colleague.

Communication Miscue: It Happened to Me

I found myself in somewhat of a sticky situation that was directly related to a breakdown in communication related to the use of email rather than traditional face-to-face or phone communication.

The situation was this: A meeting was requested by one of the team members to the administrative assistant. The assistant (Jane) spoke with the Team Leader (Joe) and sent out an invite for a conference call. When the Outlook invite was emailed to the team, I noticed that one of the key members wasn’t listed.

I sent this email to Jane: “Do we need to have Sarah on this call? Just me thinking out loud…”

Innocent request, I thought. Quickly, I receive this email back: “Hi Ginger. As Sarah is a vice president, she attends our meetings and is a vital part of all we do. The topics you requested to be discussed on the call would be beneficial for Sarah to be a part of. If you feel that Sarah should not be a part of this Team call, please address with her directly. Thank you, Jane.”

Clearly after reading the response from Jane, I replied back and told her simply that I had not seen Sarah on the invite and want to make sure that she was included. My intention was the opposite of what she interpreted from my initial email.

This illustrates how easily email and text communication can be taken out of context or completely misinterpreted. It’s the responsibility of the sender to ensure that the recipient understands the message. This may be very difficult when using email or text messages.

In the end, Sarah picked up the phone, we discussed the misunderstanding “old school” and it was cleared up in seconds. And then we laughed!

An additional pitfall with electronic communication is the use of specialty fonts, bolded text and colored texts. When you type in ALL CAPS, it gives the impression that you are shouting at the recipient. The same can be said for BOLDED or Red text in email or texts. One should use care when selecting enhancements to the normal font or typeset. I offer this suggestion: If there is a message that’s so important that you feel it needs to be in bold, italic, ALL CAPS, underlined or colored, consider picking up the phone or walking down the hall to deliver that message. You run less risk of having the communication misinterpreted that way.

Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services for the Alliance Group. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.